Healthcare Provider Details

I. General information

NPI: 1427032218
Provider Name (Legal Business Name): JANE A DANOWIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 COMMANCHE AVE
GREEN BAY WI
54313-6089
US

IV. Provider business mailing address

1630 COMMANCHE AVE
GREEN BAY WI
54313-6089
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-4585
  • Fax:
Mailing address:
  • Phone: 920-430-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41751
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41751-02
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: